Reconciliation deadline looms in April -- House may vote next week on insurance industry’s antitrust exemption -- Obama pledges to finish reform

A NEW DEADLINE LOOMS — The reconciliation instructions expire when Congress passes the next budget resolution, which usually happens in April, Senate Budget Committee Chairman Kent Conrad confirmed Tuesday. That means health care reform has another firm deadline if Congress decides to move ahead with reconciliation, which still appears to be Democrats’ preferred method. A new possible timeline: Figure out how to proceed on health care by the February break, pass a jobs bill to rack up a win after the break and complete action on health care by the Easter break. Senate Majority Leader Harry Reid said Tuesday he hopes Democrats can decide by next week on a way to move the health care bill forward. In terms of procedure, Reid said the Senate cannot pass a reconciliation bill before the House does because revenue measures must start in the House. He acknowledged that Democrats are considering having the House pass the reconciliation bill first, followed by the Senate. The House could then pass the comprehensive Senate reform bill. Agreement between the House and Senate on the order of the bills would help ease passage. House Democrats have insisted that they will not pass the Senate bill before changes are made. But Reid is far from persuading his own caucus to pass the cleanup bill on reconciliation. Reid and Senate Finance Committee Chairman Max Baucus dropped by the regular Tuesday meeting of Senate centrists — and asked them to withhold judgment on using reconciliation to pass health care reform until they see a package. Senate moderates have been among the most vocal skeptics of the procedural maneuver, warning that it would further taint attempts to work across the aisle. POLITICO has identified at least 10 senators who have said they are opposed to reconciliation or have expressed strong reservations. Reid can only afford to lose nine senators and still pass a bill.

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POTUS SPEAKS TO and takes questions from the Senate Democratic Policy Committee Issues Conference at 10 a.m. at the Newseum.

HOUSE TWO-TRACK SET TO BEGIN, reports POLITICO’s Patrick O’Connor and Budoff Brown: “With the broader health care bill still perilously close to collapse, House Speaker Nancy Pelosi plans to take a shot at the health insurance industry next week by scheduling a vote on a smaller bill to revoke its half-century-old exemption from antitrust laws. The vote is part of her new two-track strategy to tackle things that won’t be included in a more sweeping bill — if Congress ever passes one — while giving her members something politically popular to vote on. The move also puts pressure on Republicans, the industry and wavering Democrats, who wish their leaders would abandon the push altogether. The bill comes as party brass struggles to find a path forward in the broader health care reform effort and amounts to a concession to her caucus as more sweeping legislation twists in the wind. The House bill would resemble a section of the House health care bill that ends an exemption for health and medical malpractice insurers and grants the federal government more authority to regulate antitrust laws. The Senate didn’t include an antitrust provision in its health care legislation because Majority Leader Harry Reid (D-Nev.) couldn’t muster the 60 votes needed to include it. Also, Nebraska Democratic Sen. Ben Nelson — himself a former state insurance commissioner — opposed the House measure, so the bill would face long odds in the Senate. But leaving a meeting with Pelosi, Reid said, ‘We will be happy to look at it.’”

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OBAMA PLEDGES TO FINISH REFORM, reports NYT’s Peter Baker from Nashua, N.H.: “President Obama hit the road again Tuesday to promote the new job-creation program he described as his No. 1 priority, but he refused to abandon his embattled health care legislation, vowing to ‘punch it through’ resistance in Congress. In a feisty and at times biting performance, Mr. Obama said the rising national debt ‘keeps me awake at night,’ but put much of the blame on his predecessor and on unrestrained health care spending that he wants to rein in. The New Hampshire visit was the latest stop on Mr. Obama’s tour of the country that is intended to recalibrate his presidency after the special election in Massachusetts cost his party unfettered control of the Senate. His town-hall-style meeting at a local high school here was the fifth time he had taken questions from an audience or over the Internet in 12 days, and he rejected the notion that the Massachusetts election doomed the health care overhaul. ‘Suddenly everybody says, ‘Oh no, it’s over,’ Mr. Obama said in mocking tones. ‘Well, no, it’s not over. We just have to make sure that we move methodically and that the American people understand what’s in the bill.’ The strong emphasis on health care came a week after he did not mention it until deep into his State of the Union address, and he seemed intent on erasing any doubts about his commitment. ‘We had to go into overtime,’ Mr. Obama said. ‘But we are now in the red zone. That’s exactly right. We’re in the red zone. We’ve got to punch it through.’”

DEMS LOOKING FOR A SMALL VICTORY, reports WSJ’s Janet Adamy and Patrick Yoest: “With their sweeping health-care bill on hold, House Democrats plan to revive a sliver of the legislation as soon as next week that would repeal an antitrust exemption for insurance companies. The move underscores growing doubts on Capitol Hill that Democrats can pass their ambitious plan to expand health insurance to more than 30 million Americans. After focusing intensely on health care for months, Democratic leaders have removed completion of the overhaul from their agenda indefinitely, and even talk of the subject is scarce. Instead, House Democrats are turning to a targeted provision with populist appeal in search of a small victory. They say repealing the federal antitrust exemption would drive insurance prices down in regions where one health insurer dominates. Insurers say they already face tight regulation by the states, and the practical impact of the move is uncertain. Top Democrats said Tuesday they remained confident they would pass a broader health bill, but they acknowledged they had no time frame for doing so and no feasible strategy in sight. House Majority Leader Steny Hoyer, a Democrat from Maryland, when reminded that he said last week Democrats would have a plan by now, responded: ‘Did I say that? I was in error.’ … A House Democratic aide said leaders hoped the measure would revive the momentum for the broader bill.”

PELOSI: PIECEMEAL REFORM WORTHLESS, reports HuffPo’s Ryan Grim: “Amid the wreckage of the health care debate, some rescue workers have been searching for small pieces that could be salvaged. On Tuesday, House Speaker Nancy Pelosi (D-Calif.) suggested that the search was in vain. What good is a door, after all, without a building? The health care system is so complex, Pelosi argued, that it can't be changed piece by piece. She used the example of the popular ban on discriminating against people with preexisting conditions: Simply passing a law saying that all insurers must take such people would lead either to prohibitively expensive insurance for them, an increase in premiums overall, or both. Passing such a bill might be politically popular, but it wouldn't help real people, she said. ‘There are some things that sound easy, but you might as well send somebody a get well card, because they don't have any more impact, except maybe they make you feel good for the moment,’ said Pelosi, who paused and rethought her comparison. ‘Maybe a get well card might be more effective, as a matter of fact, because it's sincere,’ she said.”

IMAGINING BIPARTISANSHIP — NYT’s David Herszenhorn rides the trolley to the Land of Make-Believe: “For all the handwringing among Democrats about the fate of their health care legislation following the Republican victory in the Massachusetts special election for United States Senate, one thing party leaders have not said is that they would use the political setback as an opportunity to write a better bill. … They have not suggested, perhaps because of the exceedingly bellicose comments by Republican Congressional leaders, is that they would try to rewrite the bill in such a way that lawmakers in both parties would find it virtually irresistible. Congressional Democrats, generally speaking, say the time for substantive debate of the health care legislation has passed and that it is politically naïve to think that a bipartisan deal is possible in the tense political climate of a mid-term election year. But just for fun, let’s imagine that Democrats, answering Mr. Obama’s call for greater collaboration and collegiality in Washington, decided to give it one more try. If they did, they just might start with a phone call to Representative John Shadegg, Republican of Arizona, who recently said he would retire after this year, at the end of his eighth term in Congress. Why Mr. Shadegg? … Few things focus the minds of public officials on their accomplishments and their failures than their impending departure from public office. With months left to serve, the word ‘legacy’ looms large. Liberated from an urgent need to satisfy constituents, donors and interest groups, largely freed from the shackles of party loyalty and spared attack by the opposition, retirees can vote as they please.”

COMPARATIVE EFFECTIVENESS GETS A BOOST, reports Kaiser Health News’s Mary Agnes Carey and Julie Appleby: “The Obama administration, in an effort to forge ahead with its sometimes-contentious effort to compare various medical treatments, is proposing a big boost in funding for the agency that oversees the research. Proponents say the research can provide patients and their doctors with crucial information to help them decide among various drugs or treatments. Critics, on the other hand, say the research could be used to limit or ration care if the federal government or insurers used the information to deny coverage for a particular test or procedure because it was found to be less effective. The administration, releasing its 2011 budget request to Congress on Monday, proposed spending $286 million on comparative effectiveness research overseen by the Agency for Healthcare Research and Quality. The agency got $21 million for such research in its current fiscal-year budget, and an additional $300 million for such research in the economic stimulus bill. Efforts to compare drugs or treatments are not new; private insurers and Medicare consider medical evidence at times in a bid to determine whether a new treatment works well for particular types of patients. But the research is often controversial.”

DOC FIX STILL UNDONE, reports POLITICO’s Frates: “Doctors and seniors lobbying to stave off looming annual Medicare cuts have won a reprieve of sorts but are still pushing for a permanent fix. The Senate on Thursday passed so-called pay-go legislation that would require Congress to pay for much of its future spending without adding to the deficit, but it exempted $82 billion from the requirement to prevent reductions to doctors’ Medicare reimbursement rates. The move is significant because it would allow Congress to prevent five years’ worth of cuts. But Congress still must authorize the spending, which lawmakers are expected to consider this month. Otherwise, doctors would face a 21 percent cut in reimbursement rates beginning in March. If Congress does a five-year fix, it would be the longest stretch lawmakers have approved since they began staving off the cuts in 2002. But some advocacy groups want the systemic problem solved permanently.”

PULSE OP-ED:

Sen. Susan Collins (R-Maine) in the Portland Press Herald/Maine Sunday Telegram: “A recent column challenged me to put forth my ideas on controlling health care costs and said that the ‘debate (on cost) should start after the establishment of universal health care.’ Contrary to the columnist's view, I believe that cost control is essential for reform. I am disappointed that the Senate bill did not do enough to rein in costs and to provide consumers with more affordable choices. Unless costs are brought under control, an expansion of coverage will be unsustainable in the long run. Throughout Maine, families and small businesses are struggling with the soaring costs of health insurance. Yet, the Senate bill would increase health care costs and impose billions of dollars in new taxes, fees and penalties. Many of these new taxes and fees would be passed on to consumers. According to the government's own actuary, America would actually spend $234 billion more on health care if this legislation were to become law. I could not support such a bill. The good news is that some areas of the country, including Portland, are leading the way in developing models that provide excellent health care at a lower cost. Studies show that other areas, however, such as Louisiana, provide lower-quality care at a much higher cost.”

(EDITED BY TIM ALBERTA)

** Turn to diagnostic medical technology for faster results in lowering health care costs. Consistent testing for drug-resistant infections can save nearly $7 billion per year for the U.S. health care system. Faster, more accurate diagnostic tests can identify patients with infections when they enter a health care facility — allowing for immediate, more targeted treatment while preventing the spread of infections. Diagnostic medical innovation saves lives, reduces the length of hospitalization and lowers health care costs. Learn more at www.AdvaMed.org. **

** A message from PhRMA: Diabetes is a complex disease affecting more than 30 million Americans – with one-in-ten living in DC, Maryland and Virginia having the disease. Thanks to advances in diabetes care, patients around the country are living longer, healthier lives. Take five-year-old Rhys for example [link to his I’m Not Average profile]. He was diagnosed with type 1 diabetes at 15-months-old, but today, he is a thriving young boy. This is due in large part to new and innovative medicines developed by researchers and scientists at America’s biopharmaceutical companies. Learn more about the medicines in development for diabetes here. **

Authors:

About The Author

Chris Frates began covering politics before he was old enough to vote. Since his early days covering town council meetings run by three guys behind a folding table, Frates has been fortunate enough to cover government on every level.

An original Politico, Frates covers the intersection of money, politics and policy inhabited by Washington’s lobbyists and writes about national politics. During the health care reform debate, Frates wrote for the paper and was the lead writer of Live Pulse, the website’s health care reform blog. Frates also founded and wrote Politico Pulse, the popular, daily health reform e-mail briefing that quickly became Washington’s must-read crib sheet.

Before coming to Washington, Frates spent more than four years at The Denver Post where he wrote about state politics. Frates covered the 2004 Democratic takeover of the Colorado statehouse, a forerunner of the political tsunami that would hit Congress two years later, and the 2006 governor’s race.

His work has appeared in The Washington Post, The Boston Globe, The Dallas Morning News and dozens of other publications. Frates has covered three statehouses and numerous campaigns.

His political analysis has been featured on the CBS Evening News, CNN, Fox News, MSNBC, WTOP and many other national and local television and radio programs.

Of all the important people he has interviewed, Frates still counts Mister Rogers among his favorites.

About The Author

Carrie Budoff Brown is the Editor of POLITICO. Previously, she was the Managing Editor of POLITICO Europe. She began her career in journalism at the York (Pennsylvania) Daily Record in the summer before her freshman year in college. She worked as an editor at The Daily Targum, the student-run newspaper of Rutgers University, and interned at the Richmond Times Dispatch and The New York Times. She worked as a staff writer at the Hartford Courant and the Philadelphia Inquirer before arriving at POLITICO on the day it launched in 2007. Between 2009 and 2014, Budoff Brown served as POLITICO’s White House correspondent. She has covered the Senate, the 2008 Obama presidential campaign, the 2010 health care overhaul bill, Wall Street reform and various tax cut battles in U.S. Congress.